student finance wales EMA Education Maintenance Allowance Application Form for 2014/15

Transcription

1 student finance wales EMA Education Maintenance Allowance Application Form for 2014/15

2 How to complete this application form Student you must: Parent /Guardian/Partner you must: Complete sections 1 to 8 of this form Sign your agreement on page 9 Send your original birth or adoption certificate and proof of address Complete sections 9 and 10 of this form Sign your agreement on page 14 Send your original financial evidence for tax year Remember: Read the notes when you see n. Some sections will refer you to the notes to tell you exactly what you need to send. You must send in original evidence to support your application when you see. Some sections will refer you to the notes to tell you exactly what you need to send. If you can t give us your evidence just now, send the completed form back without it. You ll have to provide the evidence before we can pay you and we ll contact you for this. Additional help and information For the most up to date information go to: If you need to speak to someone about EMA you can call us on All our forms and guides are available in Braille, large print format or audio. If you need this, you can your name, address and details of the format you need to: brailleandlargefonts@slc.co.uk or call If you have someone who s authorised to act on your behalf and/or hold funds on your behalf, this third party must also complete section 12. e! You must have sent your application, information and all evidence by 31 August This is the last date we can accept your information and evidence. The sooner you return your completed form and original evidence, the quicker you ll get your EMA. 2 /B

3 INTERNAL REFERENCE NUMBER: (For internal use only) Student Section 1 Your details n If you re an existing EMA student, please provide your Customer Reference Number: 1.1 Title Mr Mrs Miss Other First name(s) Surname/Family name Sex Male Female Date of birth DAY MONTH YEAR In which town or city were you born? e Send your original birth or adoption certificate to prove your identity. 1.2 Home address You must usually live in Wales to be! eligible for EMA. Home telephone number Postcode Mobile telephone number (We may contact you by text message) address e Send proof of address in Wales (if you live with your parent(s)/guardian(s) this can be in their name). This can be a Tax Credit Award tification (TCAN) or a utility bill (like a gas or electricity bill dated within the last three months). You can see an example TCAN on page 10 of the notes. 3

4 Student Section 1 Your details (continued) Security question 1.3 What was the name of your first school? We ll use this information for a security check. You ll be asked to confirm this answer if you call us to discuss your account. Student Section 2 Your school or college details 2.1 Enter the details of the school or college where you intend to study from September If you don t know where you ll study from September 2014, give the details of your current school or college. You ll need to call us to update these details before the start of term. Name of school or college Campus If applicable School or college address Postcode 4

5 Student Section 3 Your nationality and residency details n the option that best describes your status and follow the instructions. e You must provide evidence of your nationality. Read pages 4 and 5 of the notes to find out what original documents you need to send us. n 3.1 I am a UK national OR I have Settled Status or Indefinite leave to Enter or Remain in the UK Have you been ordinarily resident in: the UK the EU/EEA Switzerland for 3 years before the start of the first academic year of your course? If go to section 5 If go to section I am an EU national Have you been ordinarily resident in the UK for 3 years before the start of the first academic year of your course? If go to section 5 If check if another option applies to you, if not go to I have, or a family member * has, been granted Leave to enter or remain for; Humanitarian Protection or Discretionary Leave in the UK Have you been ordinarily resident in the UK since this status was awarded? If go to section 5 If check if another option applies to you, if not go to I have, or a family member * has, Refugee status in the UK or EU temporary protection status in the UK Have you been ordinarily resident in the UK since Refugee status was awarded? If go to section 5 If check if another option applies to you, if not go to 3.8 * Your family member means your husband, wife, civil partner, parent or step-parent. 5

6 Student Section 3 Your nationality and residency details (continued) n e You must provide evidence of your nationality. Read pages 4 and 5 of the notes to find out what original documents you need to send us. n 3.5 I am a child of a Swiss national Will your Swiss national parent be living in the UK on the first day of your academic year? n 3.6 I am, or a family member * is, an EEA or Swiss national who is working/has worked or is looking for work in the UK Have you been ordinarily resident in: the UK the EU/EEA Turkey Switzerland for 3 years before the start of the first academic year of your course If go to section 5 If check if another option applies to you, if not go to 3.8 If go to section 5 If check if another option applies to you, if not go to I am a child of a Turkish national who is working/has worked in the UK Have you been ordinarily resident in: the UK the EU/EEA Turkey Switzerland for 3 years before the start of the first academic year of your course If go to section 5 If check if another option applies to you, if not go to ne of these n You are not eligible for EMA * Your family member means your husband, wife, civil partner, parent or step-parent. 6

7 Student Section 4 Your residency history 4.1 Details of your residence for the three years before the start of the first academic year of your course. First address From DAY MONTH YEAR To DAY MONTH YEAR Why were you there? Second address From DAY MONTH YEAR To DAY MONTH YEAR Why were you there? Third address From DAY MONTH YEAR To DAY MONTH YEAR Why were you there? 7

8 Student Section 5 Your independence details You should answer every question in this section. 5.1 Do you live apart from your parent(s)/guardian(s) and have no contact with them? n e You must provide evidence of your independence. Examples of evidence items can be found in the notes. n 5.2 Are you living under Local Authority care? (for example, with foster parents) n 5.3 Do you receive Income Support or Income Based Employment and Support Allowance, or Universal Credit in your own name? n n 5.4 Are you responsible for a child? 5.5 Are you currently a young person in custody/detention within the Youth Justice System? n If you answered to any of the questions above you may be considered Independent. If you answer to all of the questions above you are considered Dependent. n! As a dependent student you need to prove your financial dependency. e You need to send us your household s Tax Credit Award tification (all pages). Dependent students If you are a dependent student your parent(s)/guardian(s) need to complete sections 9 and 10. Independent students If you answered to 5.1 then you (and your partner, if you have one) must complete sections 9 and 10. Independent students For all other independent students, sections 9 and 10 don t have to be completed. Section 6 Your UK bank or building society account details This account must be in your own name and be able to accept direct credits. Missing or incorrect bank or building society details will result in your payments being delayed. If you have any exceptional circumstances which mean your EMA payments would be made to someone else s account, tick here This section should be completed with bank or building society details of someone who is authorised to hold funds on your behalf. This person will also need to complete section 12. Account holder s name Sort code Account number Building society roll number (if applicable) 8

9 Student Section 7 Consent to share n The information you provide on this form will be shared with the Welsh Government, Student Loans Company and/or any other institution who assist in the administration of your EMA application or in monitoring the performance of the student finance system. If you do not consent to your information being used for market research tick here. Important information if you live with your parent(s)/guardian(s) or a partner: It is important that we know if you will let us talk about your application and award with your parent(s)/ guardian(s) or partner. We cannot give out information about your application and award to anyone without your agreement. I consent to the EMA Wales Customer Services Team providing details of the progress of my application and award to the person named as person 1 in section 9 of this application form. and, if appropriate I consent to the EMA Wales Customer Services Team providing details of the progress of my application and award to the person named as person 2 in section 9 of this application form.! Student Section 8 Student agreement If you are a third party completing this form on behalf of a student who is unable to sign the agreement, you should leave this agreement blank and complete section 12 instead. We will not be able to process your application for EMA unless you sign and date this agreement. You should also read the Data Protection Statement, on page 12 of the notes that accompany this form. The statement sets out who will use the information given on this application form and what they will use it for. I confirm that the information I have given on this form is correct and complete to the best of my knowledge and belief. By signing this agreement, I confirm that I have read and understood the Data Protection statement. I confirm that I have submitted supporting evidence in accordance with the notes. I understand that any attempt to dishonestly obtain EMA shall be treated as fraud and may result in criminal and/or civil proceedings against me. w sign here: Your full name (in BLOCK CAPITALS) Your signature X Date / / 9

10 Student Student Checklist Have you answered all the questions that apply to you in sections 1 to 7? If you don t answer all the questions we will have to write to you to ask you for more information. This will delay your application for EMA. Have you included all the original evidence we need with this form? If you don t send the original evidence requested then we will have to write to you to request the evidence. This will delay your application for EMA. Have you signed and dated the student agreement in section 8? Next steps: In section 5 you worked out whether you are a dependent or an independent student. If you re a dependent student Give the application to your parent(s)/guardian(s) so they can complete sections 9,10 and 11. If you re an independent student Refer back to page 8 to see if you (and your partner if applicable) need to complete sections 9,10 and 11. Remember If someone else (an authorised third party) is acting on your behalf and/or managing/holding funds on your behalf, that third party needs to complete section

11 Parent/Guardian/Partner You should complete this section if: Section 9 Financial details n You are the parent(s)/guardian(s)/partner of a student or you are an independent student. If you are an independent student enter your income details under person 1. Your partner (if applicable) should enter their details under person 2. Give financial details for the tax year 6th April 2013 to 5th April Where you tell us an amount, you must provide evidence to support it. If you need help with any questions you should refer to the notes each time you see n If your household income has changed since April 2014 read page 7 of the notes n 9.1 Relationship to student First name Surname person 1 n person 2 n Benefit income 9.2 Has your household been issued with a Tax Credit Award tification for tax year ? Enter your total annual household income as it appears on your Tax Credit Award tification if, e you ll need to send us evidence of this, now go to section Is either person 1 or person 2 in receipt of a taxable household income? Examples of taxable household income can be found in the table on page 7 of the e notes n If, go to Is either person 1 or person 2 in receipt of Income Support or Income Based Employment and Support Allowance? If, e you ll need to send us evidence of this, now go to section Is either person 1 or person 2 in receipt of Universal Credits? e If, you ll need to send us evidence of this, now go to section 10 e You must provide original evidence for every question you enter an amount for. Types of evidence you must send can be found in the notes. If you don t send the correct evidence this will delay the application for EMA. 11

12 Parent/Guardian/Partner Household income Section 9 Financial details (continued) 9.4 Please provide information for tax year : Gross salaries and wages Self-employment income Taxable Social Security Benefits person 1 person 2 Other income: person 1 person 2 Type Type Type Type person 1 person 2 TOTAL HOUSEHOLD INCOME Deductions 9.5 Private pension contributions person 1 person 2 Additional Voluntary Contributions (AVCs) Wages for domestic help because of incapacity Any other expenses connected with employment TOTAL DEDUCTIONS 9.6 TOTAL INCOME n (This is your 9.4 TOTAL HOUSEHOLD INCOME minus 9.5 TOTAL DEDUCTIONS) e You must provide original evidence for every question you enter an amount for. Types of evidence you must send can be found in the notes. If you don t send the correct evidence this will delay the application for EMA. 12

13 Parent/Guardian/Partner Section 10 Family details! Only complete this section if the following applies to you: The household income is between 20,817 and 23,077 and You have a young person(s) aged 20* or under, other than the applicant, who will qualify for child benefit or are in full time further education/training and qualify for child benefit, and live in the household. If your household income is 23,078 or above, you will not be eligible for EMA Is your household income 20,817 or less per year? n go to section 11 go to Are there any young people in your household who are under the age of 20* (other than the applicant) who: qualify for child benefit; or are in full-time education or training and qualify for child benefit. go to the applicant is not eligible for EMA Is your household income 23,077 or less per year? go to the applicant is not eligible for EMA e n You will need to send us evidence about the young person/people in your household to show their date of birth and that they live in your household. The types of evidence you can send can be found in the notes Enter details below of any young people under the age of 20* (other than the applicant) in your household. Full name(s) of young people under 20 Date of birth DD/MM/YYYY * Age 20 or under on 1 September

14 Parent/Guardian/Partner Section 11 Parent(s)/guardian(s)/partner agreement We will not be able to process this application for EMA unless you sign and date this agreement. You should also read the Data Protection Statement, on page 12 of the notes that accompany this form. The statement sets out who will use the information given on this application form and what they will use it for. I confirm that the information I have given on this form is correct and complete to the best of my knowledge and belief. I understand that any attempt to dishonestly obtain EMA shall be treated as fraud and may result in criminal and/or civil proceedings against me. By signing this agreement, I confirm that I have read and understood the Data Protection statement. person 1 Your full name (in BLOCK CAPITALS) person 2 Your full name (in BLOCK CAPITALS) Your signature X Your signature X Date / / Date / / Parent(s)/guardian(s)/partner checklist Before you return this form, have you: Answered all the questions that apply to you in sections 9 and 10? If you don t answer all the questions we ll have to write to you to ask you for more information. This will delay the application for EMA. Attached original evidence items to the application form if applicable? If you don t send the original evidence requested we will have to write to you to request the evidence. This will delay the application for EMA. If you can t give us the evidence we need straight away, return the form without it. You ll still have to provide the evidence later and we ll contact you for this. Signed and dated the above agreements?! Remember If the student has an authorised third party who ll help manage their finances and/or act on their behalf, this third party needs to complete section

15 Section 12 Third Party Agreement n! This section must be fully completed if someone will be: acting on the student s behalf to manage their application and continuing participation to EMA; or holding and managing the student s EMA payments; or both Read both options carefully and tick one or both options depending on your situation. e Option 1 Third party has completed/signed the form on the student s behalf. The student named in Section 1 is unable to complete/sign the form for themselves, and I have done so on their behalf. I confirm that the information I have given on this form is correct and complete to the best of my knowledge and belief. I confirm that I have submitted supporting evidence. I confirm that the student named in section 1 has not been in receipt of any other funding from the Welsh Government for this level of study or course. I have provided my contact details below. I have enclosed appropriate evidence documentation to confirm that I am authorised to act on the student s behalf. If required, I will contact the EMA Customer Services Team about the progression of the student s EMA application and to advise on any changes to any of the information contained in this form. If Option 1 applies please tick here. Option 2 Third party is authorised to hold funds on the students behalf. The student named in section 1 is unable to have a bank account in his/her own name. I am authorised to hold funds on the student s behalf and have provided my bank details for this reason. I will hold any payments made as a result of this application on behalf of the student and use them in accordance with the student s instructions. I have enclosed appropriate evidence to confirm that I am authorised to accept payments on the student s behalf. I have provided my contact details below. I will contact the EMA Customer Services Team about any changes to my contact details. If Option 2 applies please tick here. Third party contact details Complete the following then sign and date where instructed. te If any of the fields below are left blank this could delay EMA payments. YYour full name (in BLOCK CAPITALS) Your signature X Date DAY MONTH YEAR Address Postcode Home telephone number Mobile telephone number address 15

16 ! 3 things to remember: 1 Check the postage g Make sure the application form and envelope are weighed and that you have paid the correct postage before you post your EMA application form We recommend that you get free proof of postage when sending your form to us. If you don t pay the correct postage this could result in late payment of your EMA. This may also result in a delay in us returning any evidence items to you. 2 Send the form, You must return your completed form and original supporting evidence to the address shown below as soon as possible. If you don t have all the evidence we need send us your application now and send us your evidence as soon as you have it. EMA Wales Customer Services PO Box 5596 Glasgow G52 9BR If you have not heard from us two weeks after sending your form, please contact us on If you have hearing difficulties, and wish to speak to an advisor using a textphone, please contact us on Get paid on time To make sure your EMA application is assessed and ready for the start of term send your completed form back to us, with all the appropriate original evidence, by June If you can t send the evidence right away, complete and return the form without it and we ll contact you again for the evidence. Other information and dates: 8 weeks from the start of your course You can only get payments backdated to the start of term if you return the completed form, and appropriate original evidence, within 8 weeks of the start of your course. 31 August 2015 You should return your application form and evidence as soon as possible.this is the final date that we can accept any information and evidence from you to be eligible for EMA in academic year 2014/15. 16

17 Equal opportunities monitoring voluntary questionnaire The following questions are voluntary you do not have to answer them. Whether you answer them or not will not affect your application for an EMA. If you do answer, the information may be used to help the Welsh Government develop its policies in the future. 1. Do you consider yourself to have a disability? 2. What do you consider your nationality identity to be? (Choose as many or as few as apply). Welsh Irish English British Scottish Other 3. Choose ONE section from A to E, then tick the appropriate box to indicate your ethnic group. A White British Any other white background PLEASE RETURN THIS COMPLETED QUESTIONNAIRE WITH YOUR APPLICATION FORM B Mixed White and Black Caribbean White and Black African White and Asian Any other mixed background C Asian or Asian British Indian Pakistani Bangladeshi Any other Asian background D Black or Black British Caribbean African Any other black background E Chinese or other ethnic group Chinese Any other 17

18 Additional notes 18

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20 Additional notes 20